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Ask the Doctor: Prostate Health

For men of a certain age, the prostate is an unavoidable, if sensitive, health topic. Dr. Damon Dyche, a urologist, has seen a lot of prostates—healthy and otherwise. Here he provides insights that will expand your understanding of this important organ, as well as answer the big question: When should you start worrying about prostate cancer screenings?

Q: What is the prostate?

A: It’s an organ found only in men. It’s a part of the urinary system, located between the bladder and urethra. The prostate surrounds the urethra like a doughnut. When you urinate, the urine passes from the bladder, through the prostate, and into the urethra to be expelled. The function of the prostate is to receive sperm from the ejaculatory system and secrete additional fluids that are a part of the ejaculate.

Q: How is an enlarged prostrate treated?

A: The prostate enlarges with aging. It can grow in overall size as well as grow inward, narrowing the urinary stream. This process is called Benign Prostatic Hyperplasia (BPH). A narrowed or blocked urinary stream can lead to symptoms such as a slow stream, straining to urinate, feelings of incomplete bladder emptying, waking up at night to urinate, urinary urgency and frequent urination.

Just because you have an enlarged prostate doesn’t mean that you will have urinary symptoms. If there is minimal internal growth of the prostate, then the flow of the urinary stream may not be affected. The decision to treat an enlarged prostate is based on the severity of a patient’s symptoms and how this has affected the patient’s quality of life.

Initial treatment is with medications that either relax the prostate tissue or shrink the size of the prostate—in order to help open up the prostate and allow the urine to pass through. If medications fail, there are minimally invasive office or surgical procedures that are available. During an office visit, a specialized catheter can be passed into the prostate that delivers microwave energy to the prostate to help open up the urinary channel. Operative procedures include using either electrical or laser energy to core out the inside of the prostate.

Q: Who is at risk for prostate cancer?

A: Prostate cancer, like BPH, is more prevalent with increasing age. Unlike BPH, prostate cancer rarely causes any urinary symptoms because it usually grows in the outer rim of the prostate, as opposed to the area surrounding the urethra. The outer rim of the prostate is adjacent to the rectum, and that is why a rectal examination of the prostate is a part of the screening process.

Prostate cancer affects one in every six men and is the second leading cause of cancer death in men. Men with a family history of prostate cancer, especially a brother or a father, are much more likely to get the disease. The risk of prostate cancer also differs with race. African American men are more than twice as likely to get prostate cancer than Caucasian men.

Q: What are your screening recommendations?

A: The prostate produces a protein called Prostate Specific Antigen (PSA) that is measured in the blood as a screening test for prostate cancer. There has been a lot of controversy in the news recently about the U.S. Preventative Services Task Force’s (USPSTF) recommendation against prostate cancer screening.

I follow the National Comprehensive Cancer Network (NCCN) and the American Urologic Association (AUA) treatment guidelines that base screening recommendations on the current literature and expert urologist/oncologist opinion. These two groups recommend both a digital rectal examination and a baseline PSA test at age 40.